Dr. Forley is listed in the 2020 Super Doctors annual guide to the top 5% of New York City physicians as seen in a magazine supplement in the Sunday edition of the New York Times on May 10, 2020. This marks the 13th consecutive year that Dr. Forley has been selected as a Super Doctor. Physicians are asked to submit nominations of outstanding colleagues as part of the selection process. Evaluation by the research staff, a peer review of candidates by specialty, and a good-standing and disciplinary check is then performed.

A survey of physicians is a part of the selection process and includes the following question: “If you needed medical care in one of the following specialties, which doctor would you choose?” Honorees are also found online at www.superdoctors.com

A common complaint of patients is that they look tired but don’t feel tired. This is often the result of bulging fat pockets in the lower lid combined with a tight attachment of the skin at the junction of the lower lid and the cheek known as the tear trough. It is frequently one of the early signs associated with the aging process. Dr. Forley approaches this concern with both a non-surgical and a surgical option. Camouflage of the bulging fat can be achieved with the use of an injectable hyaluronic filler at the tear trough to aid in blending the transition across the lid-cheek junction. Although this can improve early changes, the fundamental cause of the problem remains unaltered. An advanced surgical technique that Dr. Forley utilizes to treat this issue involves releasing the attachment of the tear trough below the eyelid from the inside so that there is no external scar. At the same time, the fat from the lower lid is repositioned to extend across the lid-cheek junction. This changes the orientation of the fat so that the bulging is reduced in conjunction with filling the depression below the lower lid. This procedure is known as a transconjunctival fat transposition lower blepharoplasty. During your consultation, Dr. Forley will discuss the options that would work best in your individual situation.

Even small amounts of excessive fat in the neck can produce undesirable contour fullness as we age. When the fat is accompanied by changes in skin tone and elasticity, the reduction of fat alone may produce the unintended consequence of skin redundancy or pleating. The NeckTite procedure provides a minimally invasive option, under local anesthesia, for combining fat sculpting with skin tightening. It utilizes an applicator below the skin to administer a layer of controlled radiofrequency energy that results in gradual contraction and tightening of the skin over 6 months without surgery and without scars. The combination of fat contouring and skin tightening can produce striking changes in the appearance of the neck that can last for years.

Dr. Forley is listed in the 2018 Super Doctors annual guide to the top 5% of New York City physicians as seen in a magazine supplement in the Sunday edition of the New York Times on May 13, 2018. This marks the 11th consecutive year that Dr. Forley has been selected as a Super Doctor. The selectionprocess includes a survey of physicians who are asked to submit nominations of outstanding colleagues. Evaluation by the research staff, a peer review of candidates by specialty, and a good-standing and disciplinary check is then performed.

The selection process includes the following question to physicians who are surveyed: “If you needed medical care in one of the following specialties, which doctor would you choose?” Honorees are also found online at www.superdoctors.com

As the aging process progresses, facial veins may appear more visible. The area around the eye, known as the periorbital region, is a frequent site for visible veins. These can become quite prominent and detract from the aesthetics of the eye. They are difficult to conceal and are a frequent complaint of patients concerned about their appearance. Fortunately, a safe and effective treatment option exists with the Ellipse Nordlys Nd:YAG laser. This device uses a specific wavelength of light that is absorbed by the red blood cells found within veins. The resulting heat that occurs results in the eventual elimination of blood flow through the veins due to the collapse of the vessel walls. The veins will disappear when blood doesn’t flow through them. The deeper veins remain untouched so there is no functional effect when treating the superficial veins. Minimal discomfort is associated with this rapidly performed treatment. One or more laser sessions may be required depending on the extent of the problem.

45 year old female 4 months following laser treatment of periorbital vein

Sagging of the face and neck with loss of jawline definition is a frequent complaint of patients as the aging process progresses. Men are particularly focused on the sagging neck as an indicator of an older appearance. However, they are less likely to accept surgery to treat the problem and are more inclined to pursue non-invasive options to improve laxity .

Ultherapy® is a non-invasive treatment that involves the application of focused ultrasound energy to the deep layers below the skin. A gradual tightening and lifting effect of the face and neck over 3-6 months results from the response of the body to the heat that is delivered. It has minimal if any downtime and is usually performed awake with some oral medication to reduce the discomfort that is associated with the procedure. Patients can resume normal activities immediately after the treatment and rarely require any pain medication or have any bruising. Maintenance treatments are usually performed at 18-24 months.

Facial aging procedures should be customized both to the changes that are visible and to the desires of the patient. In some cases, several options may be suitable to satisfy the goals of the patient. A detailed conversation between the plastic surgeon and the patient enabling shared decision making helps to maximize the likelihood of a satisfactory treatment outcome.

This case illustrates a treatment decision that involved shared decision making regarding the concerns of a 50 year old patient with facial aging. During the initial consultation, she stressed that the most worrisome aspect of her appearance was her sagging neck. Although aging changes of the face were of concern, her desire for a more limited procedure focusing on the neck was clear. We decided together that a neck lift would be performed and the outcome at 1 month is seen below. The patient was very pleased with the improvement and was gratified that she was able to achieve this result with neck surgery alone.

The aging appearance of the eye is often a combination of a progressive descent of the brow, heaviness of the upper eyelid, and a baggy appearance of the lower eyelid. The individual contributions of each of these factors varies from patient to patient and each of them can be addressed separately or in a combined procedure.

The key factor in treating the eye area is making the correct diagnosis so that the appropriate procedures are performed. If the problem is a low-lying brow, removing upper eyelid skin can make the brow appear even lower. Conversely, trying to correct upper eyelid skin redundancy with a brow lift will result in excessive brow elevation and a surprised look.

The aging lower eyelid is often a combination of prominent fat pads and a depressed lid-cheek junction or tear trough that creates a circle under the eyelid. Removing fat in the setting of a deep tear trough leaves that problem uncorrected or may even make it appear worse.

This patient example demonstrates a patient with a low-lying brow that creates a heavy appearance at the junction of the brow and the upper eyelid. The lower eyelid has a moderate amount of fat excess and depression of the lid-cheek junction that creates a tired appearance.

Treatment of the aging eye with an endoscopic brow lift and a fat transposition lower blepharoplasty

The patient underwent an endoscopic brow lift and a fat transposition blepharoplasty of the lower eyelid. The brow lift was performed using specialized instrumentation introduced through small incisions within the scalp and enabled a correction of the heavy appearance of the upper eyelid, in this case, without any skin excision. The lower eyelid was improved by releasing the tear trough ligament and draping the excess lower eyelid fat across the lid-cheek junction to fill the depression. This procedure is distinct from more traditional fat removal procedures of the lower eyelid. The combination of surgical procedures resulted in a more youthful and rested appearance that appears natural.

Disclaimer: The decision to undergo cosmetic procedures is aided by viewing photographic illustrations of the outcomes of those procedures. Certain procedures can only be demonstrated by using photographs that, although clinical in nature, may feature nudity and therefore may not be suitable for all visitors to the website.